Visible Skin Changes Research Articles

Biomonitoring of hand and forearm transepidermal water loss and skin PH among nursing apprentices.

Measurements of transepidermal water loss (TEWL) and stratum corneum (SC) pH can help indicate work-related skin barrier damage, but sensitivity to confounding personal and ambient factors limits their potential as biomonitoring tools. To evaluate the difference between hand and forearm skin barrier conditions as a tool for early recognition of workers with occupational contact dermatitis. The participants were nursing apprentices (N = 238, median age 19 years) from Zagreb, Croatia. They filled out a questionnaire based on the Nordic Occupational Skin Questionnaire, underwent a clinical examination of skin on the hands, and were evaluated for their TEWL and SC pH on the dorsum of the hand and volar part of the forearm. We found that the difference between hand and forearm TEWL values (ΔTEWL) greater than 7 g/m2/h, or >50%, or the difference in SC ΔpH >0.50, predicted visible skin changes found on clinical examination. However, only the association with ΔpH >0.50 retained statistical significance when controlled for sex, age, ambient temperature, and relative humidity in a multiple regression model. The difference between hand and forearm SC pH values is suggested as a reliable biomonitoring tool in recognition of damaged skin barrier conditions in occupational settings.

Effect of an anti-aging care product on the main morphofunctional skin parameters

Introduction. Cosmetic care occupies an important place in the correction of visible involutive skin changes. Existing high-tech methods of preserving and delivering active ingredients to the skin allow us to create unique ampoule concentrate, in particular Anti-Aging Reviving Elixir from LaCabine, the main components of which are snow algae powder, probiotics and chamomile extract.Aim. To study the effect of Anti-Aging Reviving Elixir by LaCabine on the main morphofunctional skin parameters (hydration, elasticity, pigmentation, fine wrinkles, sensitivity) and evaluate the organoleptic properties and ease of use. e for 28 days. Using the Aramo ASW device, the following skin parameters were determined before and after the course: hydration, elasticity, pigmentation, fine wrinkles, sensitivity. For a general visual assessment, photography was carried out in the aesthetics mode with the FotoFinder device.Results. The organoleptic properties, adverse events, as well as the ease of use of the properties were evaluated by an oral survey of each patient. The results showed that the course use of Anti-Aging Reviving Elixir by LaCabine leads to enhanced appearance of the skin, improved morphofunctional parameters, in particular hydration and elasticity, and reduced fine wrinkle severity. Due to ease of use and good organoleptic properties, the product is characterised by a high level of compliance.Conclusion. Anti-Aging Reviving Elixir by LaCabine can be recommended for home care as part of anti-aging skin care programs.

Modelling the cost-effectiveness of subepidermal moisture measurement as part of a process of assessment and intervention to prevent hospital-acquired pressure ulcers.

Skin tissue assessment is traditionally used to identify early signs of pressure damage from changes observed at the skin surface. However, the early onset of tissue damage induced by pressure and shear forces is likely to be on soft tissues beneath the surface of the skin. Subepidermal moisture (SEM) is a biophysical marker for the detection of early and deep pressure-induced tissue damage. Measurement of SEM can detect early pressure ulcers up to 5 days before visible skin changes occur. The aim of this study was to evaluate the cost-effectiveness of SEM measurement compared with visual skin assessment (VSA). A decision-tree model was developed. Outcomes are the incidence of hospital-acquired pressure ulcers, quality-adjusted life-years (QALYs) and costs to the UK National Health Service. Costs are at 2020/21 prices. The effects of parameter uncertainty are tested in univariate and probabilistic sensitivity analysis. In a representative NHS acute hospital, the incremental cost of SEM assessment as an adjunct to VSA is -£8.99 per admission, and SEM assessment is expected to reduce the incidence of hospital-acquired pressure ulcers by 21.1%, reduce NHS costs and lead to a gain of 3.634 QALYs. The probability of cost-effectiveness at a threshold of £30 000 per quality-adjusted life year is 61.84%. Pathways that include SEM assessment make it possible to implement early and anatomy-specific interventions which have the potential to improve the effectiveness of pressure ulcer prevention and reduce healthcare costs.

A Case of Linear Scleroderma in a Young Child: A Diagnosis Easily Missed in Primary Care.

BACKGROUND This case illustrates the challenges in diagnosing linear scleroderma (LS) in a child who presented to a primary care setting. Diagnosis of LS is easily missed due to the lack of prominent symptoms, subtle visible skin changes, and under-recognition of this condition. CASE REPORT A 7-year-old boy presented with a linear, painless, non-itchy rash at the center of his forehead, which has been present for 6 months. The rash extends vertically from the hairline to the bridge of the nose. The color gradually evolved from reddish to purplish-grey and shiny within 3 months. He had underlying eczema, allergic rhinitis, and allergic conjunctivitis since birth. His condition remained unrecognized despite consultations with various medical specialties, including family medicine specialist, ophthalmologist, otorhinolaryngologist, and a general pediatrician. Six months after the onset of his lesion, he was subsequently referred to a pediatric dermatologist and pediatric rheumatologist, who made the diagnosis of LS. Laboratory investigations for autoimmune disease showed that negative antinuclear antibodies (ANA) and inflammatory markers, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), were normal. Skin biopsy provided a tissue confirmation of the diagnosis. MRI of the lesion showed no extension into the underlying muscle or bone erosions. The patient was initially treated with intravenous (IV) methylprednisolone for 3 days, followed by oral methotrexate weekly and prednisolone. The lesion improved after 1 month of treatment, and after 15 months it was less pigmented and less noticeable. CONCLUSIONS LS is the commonest form of localized scleroderma in children. LS on the forehead can erode into the underlying tissues and is sometimes associated with extensive hemifacial atrophy. Treatment should be instituted early to prevent late irreversible fibrotic sequelae. This report aims to highlight the importance of early diagnosis and treatment of an uncommon but potentially disfiguring condition.

Which outcomes should be measured in hand eczema trials? Results from patient interviews and an expert survey.

Hand eczema (HE) is a common skin disease characterized by itch, pain and visible skin changes such as fissures, erythema and vesicles. It is not yet clear which outcome domains are most important for patients. The Hand Eczema Core Outcome Set (HECOS) initiative is developing a consented set of core domains and suitable measurement instruments for the future application in all HE trials. This includes an online Delphi survey about core domains, which requires a 'Long List' of all domains that might be important to measure. To compile a 'Long List' of candidate outcome domains for therapeutic HE trials with suggestions from patients and experts. First, 60 patients with chronic HE were interviewed at seven study sites in Croatia, Denmark, Germany, the Netherlands and Spain. Patients were asked about domains that were important from their perspectives. Second, 185 HE experts were invited by email to complete an online survey. With an open question, they were asked to suggest up to six domains. Suggestions were provided by 58 patients and 82 experts. Most patients and experts suggested to measure the domains 'signs', 'symptoms' and 'HE-related quality of life'. Specifically, >25% of patients said that less itch, pain or fissures indicated a successful treatment. Among experts, >25% suggested 'itch' and 'ability to work' as core sub-domains. Further outcomes from the domains 'HE control over time', 'patient-reported treatment experience' and 'skin barrier function' were mentioned. 'Itch' was rated high among patients with HE and professional HE experts. While patients emphasized fissures as important, experts underlined the ability to work. This investigation allowed us to define a 'Long List' of 7 candidate outcome domains with 58 sub-domains. From this list, a panel of stakeholders will select core domains during an online Delphi survey.

A Single-Center Study Evaluating the Effects of a Topical Serum Combining Postbiotics, Peptides, and Botanical Extracts on Skin.

Aging, influenced by intrinsic and extrinsic factors, leads to visible skin changes such as dryness, surface roughness, and loss of luminosity. Proper skin care can mitigate some of these effects, with topical combination products offering support through complementary mechanisms. To test efficacy and safety of GSYBS-7 (Goop Beauty Youth-Boost Peptide Serum; Goop Inc., Santa Monica, CA), a topical postbiotic and botanical combination serum, used twice daily on facial skin for 6 weeks. In this 19-patient pilot study, the primary efficacy measure was improvement on the Global Ranking Scale (GRS) at 42 days. A 12-point patient satisfaction survey and the serum's effect on healing after ablative laser treatment served as secondary and exploratory measures, respectively. Statistically significant improvements in all GRS domains were observed as early as day 7 with ongoing improvement up to day 42. A >1-point improvement was observed for dehydration (1.8; 95% CI, 1.5-2.2), visible pores (1.6; 95% CI, 1.3-2.0), surface roughness (1.6; 95% CI, 1.3-1.9), imbalance (1.3; 95% CI, .9-1.7), static wrinkles (1.3; 95% CI, .9-1.6), pigmentation (1.3; 95% CI, 1.0-1.5), and vasculature (1.2; 95% CI, .8-1.5). Independent photographic review and patient satisfaction surveys corroborated these findings. At day 42, 94.4% of patients were very satisfied with the results, and 88.9% would recommend GSYBS-7 to family and friends. No adverse events were reported, and 100% of patients indicated that GSYBS-7 was gentle enough for everyday use. GSYBS-7 appears to be an effective and well-tolerated combination topical for the management of age-related and environment-induced skin changes.

S2k guideline for diving accidents.

For the purposes of this guideline, a diving accident is defined as an event that is either potentially life-threatening or hazardous to health as a result of a reduction in ambient pressure while diving or in other hyperbaric atmospheres with and without diving equipment. This national consensus-based guideline (development grade S2k) presents the current state of knowledge and recommendations on the diagnosis and treatment of diving accident victims. The treatment of a breath-hold diver as well as children and adolescents does not differ in principle. In this regard only unusual tiredness and itching without visible skin changes are mild symptoms. The key action statements: on-site 100% oxygen first aid treatment, immobilization/no unnecessary movement, fluid administration and telephone consultation with a diving medicine specialist are recommended. Hyperbaric oxygen therapy (HBOT) remains unchanged as the established treatment in severe cases, as there are no therapeutic alternatives. The basic treatment scheme recommended for diving accidents is hyperbaric oxygenation at 280 kPa.

Efficacy of use of combined skincare routine on reduction of dermatitis symptoms

Atopic dermatitis is a chronic inflammatory skin disorder. However, careful skin care can help to control and alleviate everyday symptoms, such as very dry, irritated and red skin. The majority of the even natural skincare products aiming at the relief of the dermatitis symptoms are developed using traditional and typically irritating preservative systems being effective systems for maintaining the product often become a problem or harm to the user - causing loss of microbial diversity, causing the user to experience discomfort due to irritation. The study aims at checking the efficiency of the combined skincare routine of two formulations having been developed using a delicate preservation and lipid regeneration layer system to promote balanced skin-cell interactions and reduce homeostasis disorders in the form of skin barrier dysfunction or inflammation. Results show the overall decrease of all sensitive and visual symptoms. The most significant symptom reduction in the dimension of skin sensations was noted in burning/heat sensation and in the dimension of visible skin changes in extended vascular networking reduction. The results of the conducted study can be interpreted as indicating the beneficial effects of the use of nature-based skincare products in case of atopic dermatitis.

Clinical Presentation of Varicose Veins

Varicose vein is one type of venous insufficiency that presents with any dilated, elongated, or tortuous veins caused by permanent loss of its valvular efficiency. Destruction of venous valves in the axial veins results in venous hypertension, reflux, and total dilatation, causing varicosities and transudation of fluid into subcutaneous tissue. The first documented reference of varicose veins was found as illustrations on Ebers Papyrus dated 1550 B.C. in Athens. Evidence of surgical intervention was found in the 1860s. However dramatic advances of varicose vein management occurred in the latter half of twentieth century. Varicose veins affect from 40 to 60% of women and 15 to 30% men. Multiple intrinsic and extrinsic factors including age, gender, pregnancy, weight, height, race, diet, bowel habits, occupation, posture, previous DVT, genetics, and climate are considered to be the predisposing factors for formation of varicose vein. Other reported factors are hereditary, standing occupation, chair sitting, tight underclothes, raised toilet seats, lack of exercise, smoking, and oral contraceptives. Common symptoms are unsightly visible veins, pain, aching, swelling, itching, skin changes, ulceration, thrombophlebitis, and bleeding. The signs of varicose vein disease are edema, varicose eczema or thrombophlebitis, ulcers (typically found over the medial malleolus), hemosiderin skin staining, lipodermatosclerosis (tapering of legs above ankles, an “inverted champagne bottle” appearance), and atrophie blanche. Varicose vein is classified according to CEAP classification, the components of which are clinical, etiological, anatomy, and pathophysiology. The revised CEAP classification was published on 2020 based on four principles which were preservation of the reproducibility of CEAP, compatibility with prior versions, evidence-based medicine, and practicality.

Extreme Exposure to Filtered Far-UVC: A Case Study†.

Far‐UVC devices are being commercially sold as “safe for humans” for the inactivation of SARS‐CoV‐2, without supporting human safety data. We felt there was a need for rapid proof‐of‐concept human self‐exposure, to inform future controlled research and promote informed discussion. A Fitzpatrick Skin Type II individual exposed their inner forearms to large radiant exposures from a filtered Krypton‐Chloride (KrCl) far‐UVC system (SafeZoneUVC, Ushio Inc., Tokyo, Japan) with peak emission at 222 nm. No visible skin changes were observed at 1500 mJ cm−2; whereas, skin yellowing that appeared immediately and resolved within 24 h occurred with a 6000 mJ cm−2 exposure. No erythema was observed at any time point with exposures up to 18 000 mJ cm−2. These results combined with Monte Carlo Radiative Transfer computer modeling suggest that filtering longer ultraviolet wavelengths is critical for the human skin safety of far‐UVC devices. This work also contributes to growing arguments for the exploration of exposure limit expansion, which would subsequently enable faster inactivation of viruses.

Satisfaction from surgical treatment and its’ influence on comfort of feeling in patients with Recklinghausen disease

<b>Background:</b> Neurofibromatosis type 1 (NF-1) is one of the most common autosomal dominant disorders. Multiple benign dermal neurofibromas, café au lait spots, axillary and inguinal freckling are the hallmarks of NF-1. <br><b>Aim:</b> The aim of this paper is to verify if surgical treatment performed in patients with NF-1 is satisfactory to them and to describe demographic factors characteristic for patients with Recklinghausen disease. <br><b>Methods: </b>A special questionnaire was prepared for the study, which contained 45 questions. Seventeen patients with neurofibromatosis type 1 agreed to fill in the questionnaire aged from 22 to 61 years. <br><b>Results:</b> Surgical treatment in patients was started between 6 and 45 years of age. All patients declared their will to continue surgical treatment. After treatment patients felt more comfortable, more self-confident and sociable. The first symptoms of neurofibromatosis were seen at about 13 years of life in most patients. All women who gave birth noticed progression of the disease during pregnancy. <br><b>Conclusions: </b>Performed surgical treatment raises life comfort and increases self-confidence in patients with neurofibromatosis type 1. Due to visible skin changes in neurofibromas it is worth referring patients to Plastic Surgery Departments. Doctors dealing with patients with NF-1 should inform them about the potential heredity of the disease and that puberty and pregnancy intensify the process of skin neurofibroma development.

Proton Partial Breast Irradiation: Detailed Description of Acute Clinico-Radiologic Effects.

Introduction: Accelerated partial breast irradiation (APBI) with protons results in a very different acute effect profile than standard whole breast irradiation. We reviewed our initial experience with proton APBI and felt that a detailed description of these effects were needed to permit a common tool to compare experience with this developing technology. Methods: Sixty sequential patients treated with proton APBI on a prospective protocol were evaluated and 43 patients with a minimum six-month follow-up underwent detailed photographic and radiologic analysis. The tumorectomy cavity plus an additional 1.5 cm clinical target volume (CTV) was treated with two or three passively-scattered proton beams to a dose of 34 Gy in 10 fractions in one week. Photographs were taken at the end of radiation, at two weeks, six weeks, and every six months thereafter. Mammography was obtained at six months after radiation and annually thereafter. All visual changes were categorized using the smallest meaningful gradations in findings and are demonstrated herein. All treatment-related mammographic findings are reported. Findings: Visual and mammographic findings showed a clear time-dependent relationship and significant variation between individuals. Peak skin reaction occurred at two to six weeks after completion of therapy. At two weeks most patients had either no visible effects and patchy erythema involving <50% of the treated skin (60%). At six weeks most patients had either patchy erythema involving <50% of the overlying skin (33%) or patchy erythema involving >50% of the treated skin (28%). Only one patient developed any moist desquamation. At six months most patients had no visible skin changes (57%) or a small, circular area of mild hyperpigmentation (33%). Mammographic changes seen at six months were regional skin thickening (40%), residual seroma (14%), localized retraction (26%), and fat necrosis (2%). A subcategorized variant on the CTCAE 4.0 was developed to foster granular recording of these findings.

Prospective, double blind, randomized, controlled trial comparing vapocoolant spray versus placebo spray in adults undergoing intravenous cannulation

ObjectivesPainful diagnostic and therapeutic procedures are common in the health care setting. Eliminating, or at least, minimizing the pain associated with various procedures should be a priority. Although there are many benefits of providing local/topical anesthesia prior to performing painful procedures, ranging from greater patient/family satisfaction to increased procedural success rates; local/topical anesthetics are frequently not used. Reasons include the need for a needlestick to administer local anesthetics such as lidocaine and the long onset for topical anesthetics. Vapocoolants eliminate the risks associated with needlesticks, avoids the tissue distortion with intradermal local anesthetics, eliminates needlestick pain, have a quick almost instantaneous onset, are easy to apply, require no skills or devices to apply, are convenient, and inexpensive. The aims of this study were to ascertain if peripheral intravenous (PIV) cannulation pain would be significantly decreased by using a vapocoolant (V) versus sterile water placebo (S) spray, as determined by a reduction of at least ≥1.8 points on numerical rating scale (NRS) after vapocoolant versus placebo spray, the side effects and incidence of side effects from a vapocoolant spray; and whether there were any long term visible skin abnormalities associated with the use of a vapocoolant spray. Materials and methodsProspective, randomized, double-blind controlled trial of 300 adults (ages 18–80) requiring PIV placement in a hospital ED, randomized to S (N=150) or V (N=150) prior to PIV. Efficacy outcome was the difference in PIV pain: NRS from 0 (none) to worst (10). Safety outcomes included a skin checklist for local adverse effects (i.e., redness, blanching, edema, ecchymosis, itching, changes in skin pigmentation), vital sign (VS) changes, and before/after photographs of the PIV site. ResultsPatient demographics (age, gender, race), comorbidity, medications, and vital signs; and PIV procedure variables (e.g., IV needle size, location, number of IV attempts, type and experience of healthcare provider performing the IV) were not significantly different for the two groups. Median (interquartile range) PIV pain was 4 (2, 7) (S) and 2 (0, 4) (V) (P<0.001). Skin checklist revealed minimal erythema: S 0% (N=0/150), V: 2.7% (4/150), which resolved within 5min, and no blanching, skin pigmentation changes, itching, edema, or ecchymosis. Photographs at 5–10min revealed no visible skin changes in any patient (N=300), vapocoolant (N=150) or placebo groups (N=150). Complaints (N=26) were coolness/cold feeling S 8.7% (N=13), V 7.3% (N=11), coolness/numbness S 0% (N=0), V 0.7% (N=1), and burning S 0.7% (N=1), V 0 (0%). Patient acceptance of the vapocoolant spray was high: 82% (123/150) of the patients stated they would use the spray in the future, while only 40.7% (61/150) of the placebo group stated they would use the placebo spray in the future. Conclusions and ImplicationsVapocoolant spray significantly decreased peripheral intravenous cannulation pain in adults versus placebo spray and was well tolerated with minor adverse effects that resolved quickly. There were no significant differences in vital signs and no visible skin changes documented by photographs taken within 5–10min postspray/PIV.

Aquagenic cutaneous disorders

Aquagenic cutaneous disorders, which include aquagenic urticaria, aquagenic pruritus, and aquagenic acrokeratoderma, are a group of rare diseases characterized by skin lesions or discomfort induced by brief contact with water. Aquagenic urticaria is characterized by pruritic wheals that occur at the sites of water contact, either immediately or within minutes, and disappear within 30-60min after water removal. Aquagenic pruritus presents with severe pruritus or a stinging, tingling, or burning sensation without any visible skin changes. These symptoms occur immediately or within minutes after the skin is exposed to water, lasting for one hour or longer. Aquagenic acrokeratoderma usually presents with whitish papules and plaques, edema, and hyperwrinkling within 2-20min after brief exposure to water; symptoms disappear within minutes to one hour after drying. The pathomechanisms of these diseases are not yet fully understood, and their diagnosis is primarily based on clinical features. Treatment remains a challenge. Herein, we review the literature regarding these unusual disorders.

Alcohol Consumption, High-Density Lipoprotein Cholesterol, Antithrombin III, and Body Mass Index Are Associated with Great Saphenous Vein Reflux in the Thigh

Venous valvular reflux is the main cause of chronic venous dysfunction. However, the etiology of valvular reflux is not completely understood. We conducted this study to investigate new risk factors for venous reflux of the great saphenous vein (GSV) in the thigh. We studied 139 consecutive patients (278 legs) who underwent Doppler ultrasonography at our hospital between March 2015 and February 2016 for leg discomfort with visible varicosities, edema, skin changes, or venous ulcer in the legs. Continuous variables included age, body mass index (BMI), hematological and blood chemistry parameters, smoking (pack-years), and alcohol consumption (days). Nominal variables included sex, comorbidities, smoking status, alcohol drinking status, and specific antibodies. The relationship of GSV reflux with pregnancy and number of children was investigated in 184 legs of 92 patients among 96 female patients. On logistic regression analysis, independent factors determining GSV reflux were BMI (B=0.126, P=0.012), high-density lipoprotein (HDL) cholesterol level (B=0.029, P=0.025), duration of alcohol consumption (B=1.237E-4, P=0.016), and antithrombin III level (B=-0.036, P=0.011). In this study, the factors determining GSV reflux were higher HDL cholesterol level, longer duration of alcohol consumption, lower antithrombin III level, and higher BMI.

Clinical characteristics of aquagenic pruritus in patients with myeloproliferative neoplasms.

Aquagenic pruritus (AP) is a diffuse itching sensation that develops immediately after water contact without any visible skin changes. AP is classically associated with polycythemia vera (PV), a BCR-ABL1-negative myeloproliferative neoplasm (MPN), and can precede the diagnosis of the disease1,2. Alternatively, AP can be drug-induced or associated with various disorders (e.g., myelodysplastic syndrome, hypereosinophilic syndrome, and juvenile xanthogranuloma)3,4. This article is protected by copyright. All rights reserved.

A case of aquagenic urticaria successfully treated with omalizumab

A case of aquagenic urticaria successfully treated with omalizumab

Prospective, randomized, double-blind controlled trial comparing vapocoolant spray vs placebo spray in adults undergoing venipuncture

IntroductionTopical anesthetics are used to decrease procedural pain such as venipuncture. Advantages of vapocoolants include rapid onset, ease of application, low cost, and lack of associated pain of injection and other needlestick-related risks. We hypothesized that the pain of venipuncture would be reduced by at least 1.8 points on a 10-point numerical rating scale after application of a vapocoolant compared with placebo. MethodsWe conducted a prospective, randomized, double-blind controlled trial of vapocoolant vs placebo spray in 100 adults (ages 18-80) requiring venipuncture in a hospital emergency department or observation unit. The primary efficacy outcome was the difference in pain scores immediately after venipuncture, measured on a 10-point verbal numeric rating scale from 0 (none) to worst (10). Safety outcomes included local adverse effects (edema, erythema, blanching) and changes in vital signs (VS). ResultsPatient characteristics and venipuncture procedure were not significantly different for the 2 groups. The median (interquartile range) pain of venipuncture was 3 (1.2-5) in the placebo group and 1 (0-3) in the vapocoolant group, P < .001. Skin checklist revealed the following: vapocoolant—minimal blanching 4%, minimal erythema 18% which resolved within 5 minutes; placebo—no visible skin changes. Photographs at 5 to 10 minutes revealed no visible skin changes in any patient. There were 2 complaints: “very wet and cold on skin” (placebo) and “felt burning on skin” (vapocoolant). ConclusionThe vapocoolant significantly decreased venipuncture pain in adults compared with placebo and was well tolerated with minor adverse effects that resolved quickly. There were no significant differences in VS and no visible skin changes documented at the site by photographs taken within 5 to 10 minutes postspray/venipuncture.

EHIT with pulmonary embolism and heterozygous prothrombin mutation

A 56-year-old male patient initially presented in our clinic in January 2008 with visible skin changes and tired, heavy legs. Ultrasound examination showed bilateral insufficiency of the great saphenous vein (GSV), grade IV according to Hach, with bilateral varicosis of the lateral saphenous branches in the lower legs with grade II chronic venous insufficiency (CVI) and CEAP 4a without insufficiency of the deep veins. Secondary findings were arterial hypertension, appendectomy in 1965, tonsillectomy in 1967, reconstruction of the right cruciate ligament in 1990, partial rightsided meniscal resection in 1999 and history of gastric ulcer. As treatment measures, we recommended the continuous wearing of class 2 compression stockings and surgical treatment of the varicose veins in stages. The patient presented for the second time almost exactly 5 years later in January 2013. Findings had changed only minimally and the patient had recently suffered from thrombophlebitis of the right GSV, with occlusion extending from the mid-calf to mid-thigh. Surgical treatment was again recommended, primarily on the left side. The patient was no longer wearing the compression stockings. Therapy

Aesthetic Medicine―A Separate Field of Medicine, as a Combination of Many Medical Specialties

Aesthetic medicine is not a new area of medicine. It has been on the world’s market for several dozen years. Aesthetic and anti-aging medicine is a separate field of medicine combined with other areas such as: neurology, plastic surgery, cosmetic surgery, general surgery, orthopaedics, psychology, psychiatry, dermatology, gynaecology, andrology, endocrinology and so on. Aesthetic medicine is an area of medicine, dealing with human’s health in terms of: external appearance, image, aesthetics, well-being, visible skin changes and discomfort in the quality of life felt by a patient. The purpose of aesthetic medicine is to achieve patients’ satisfaction, as to their requirements related to the appearance, elimination of the complexes and the restoration of self-esteem. The following work shows, based on the overall impact of aesthetic medicine on the lives of patients and on the basis of the characteristics of some basic treatments in aesthetic medicine (fillers, botulinum toxin type A, intralipotherapy, needle mesotherapy, chemical peels), how this area of medicine is linked with other specialties and why it should be treated as a separate field of medicine.